术前小剂量地塞米松对老年患者术后谵妄的影响  

Effects of low does of pre-operative dexamethasone on delirum and serum corticol level in aged patients receiving non-cardiac surgery

作　　者：周岩[1] 王东信[1] 史成梅[1] 

机构地区：[1]北京大学第一医院麻醉科,100034

出　　处：《临床麻醉学杂志》2013年第3期219-221,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察术前小剂量地塞米松对老年患者非心脏手术术后谵妄的影响。方法选择212例老年择期全身麻醉非心脏手术患者,随机均分为地塞米松组和对照组。地塞米松组患者诱导前静注地塞米松10mg,对照组静注生理盐水2ml。术后1周内每天定期对患者评估护理谵妄筛选评分(Nu-DESC),记录谵妄的发生率和持续时间。术后第1天8:00AM抽取动脉血测定血清皮质醇浓度。结果谵妄发生率和持续时间地塞米松组为45例(42.5%)和(3.7±3.0)d,对照组为54例(50.9%)和(4.4±2.8)d,两组谵忘发生率和持续时间差异无统计学意义。术后第1天血清皮质醇浓度地塞米松组为(114.9±101.9)μg/L,明显低于对照组的(166.3±107.2)μg/L(P<0.01);发生谵妄的患者血清皮质醇浓度地塞米松组为(168.8±120.6)μg/L;对照组为(208.4±108.0)μg/L;未发生谵妄的患者血清皮质醇浓度地塞米松组为(65.9±41.3)μg/L,对照组为(111.2±77.7)μg/L,两组发生谵妄的患者血清皮质醇浓度均明显高于未发生谵妄的患者,且发生或未发生谵妄的地塞米松组血清皮质醇浓度明显低于对照组(P<0.05或P<0.01)。结论老年患者全身麻醉下非心脏手术术前静注10mg地塞米松,不能降低术后谵妄发生率与持续时间,但似可降低谵妄发生患者的血清皮质醇浓度增幅。未发生术后谵妄的患者术后血清皮质醇浓度降低。Objective To investigate the influence of low dose of pre-operative dexamethasone on post-operative delirum and serum corticol level in patients undergoing non-cardiac surgery. Methods Two hundred and twelve aged patients undergoing non-cardiac surgery under general anesthesia were randomly divided into two groups： dexamethasone group and control group. For the dexamethasone group, patients were given 10 mg of dexamethasone before the induction of anesthesia, while those in the control group received 2 ml of saline. All data were collected during the operation. Everyday after the operation, each patient was evaluated using the nursing delirium screening scale （Nu-DESC） to measure the incidence of delirium and its duration. The corticol level in arterial blood was measured at 8 AM on the first day after surgery. Results In the dexamethasone group, The incidence of delirium and its duration were 45（42.5%） and （3.7±3.0） d while that of control group was 54（50.9%） and （4.4±2.8） d; the serum corticol level in dexamethasone group was （114.9±101.9）μg/L and （166.34±107.2）μg/L in the control group（P〈0.01）. Conclusion 10 mg of dexamethasone before surgery will not reduce the incidence or duration of delirium in aged patients, although it can effectively lower the serum corticol level, in both delirium and non-delirium patients.

关 键 词：外科重症患者 术后谵妄 血清皮质醇 地塞米松 

分 类 号：R614[医药卫生—麻醉学]